The Need For Root Canal Therapy

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Root Canal Therapy is required when damage to healthy tooth structure nears the Pulp Chamber of the tooth. This damage could result from untreated decay, deep enamel cracks, or trauma. Occasionally, Pulp will die for no visible reason. This is believed to be caused by previous childhood trauma to the area. The Pulp Chamber houses the nerve and blood supply within the tooth. It consists of a small pool of material within the crown and thin canals which run down to the apex (tip) of the roots. Because the Pulp contains nerve fibers, infections can cause a varying amount of discomfort including extreme temperature sensitivity, pressure pain, or a throbbing ache. If left untreated, the tooth could abscess, affecting the health of the bone and causing swelling to the soft tissue on the face and neck. Root Canal Therapy not only treats the infection, but allows the patient to maintain their tooth structure, avoiding the costly restorative options of replacing an extracted tooth.

Are Root Canals Painful?

Many patients are concerned about pain during a root canal procedure. This idea has been exaggerated through television and movies. With modern dentistry, a root canal appointment is usually painless and no more uncomfortable than a Dental Filling appointment. At the Offices of Dr. Mark Freeman & Associates, our Doctors perform most of the root canal therapy required by our patients. Our office utilizes the techniques of both traditional Hand Files and modern Rotary Equipment to relieve our patient's pain; however, if a difficult case arises, our office has outstanding relationships with several Endodontist in the area that specialize and perform difficult Root Canals every day.

Procedure

After determining which tooth is causing the patient's discomfort, the patient is given local anesthesia. A small opening is made on the Occlusal (biting) surface of the tooth, down to the Pulp Chamber. On x-ray, the tooth's length is measured, and small markers are placed on the Endodontic Files to the corresponding length. The files are then run through the canals withdrawing the nerve tissue from the tooth. As the procedure progresses, the files increase in thickness until the Dentist is certain that all nerve tissue has been removed. Depending on the amount of infection, the Dentist may choose to pack the tooth with a medicated filling material and place the patient on antibiotics.

When finishing the procedure, the canals are washed and cleaned of debris with an Endodontic Solution. This ensures all bacteria in the area have been eliminated. The canals are then dried, and heat sealed with a rubber substance, one of which is called Gutta Percha. X-rays are taken during the procedure to assure the position of the material and that the canals are properly sealed.

A final filling is compressed onto the sealed root canal. This deep filling is a Core Build-Up. When needed for additional support, a Post is placed. Some of the root canal fill is removed from the largest canal, and using special rotary instruments, the canal is prepared to match a corresponding titanium Post. This Post is cemented to place and the Core Build-Up is interlocked around it. It is always recommended that a tooth which has had a root canal should eventually receive a crown to provide long term support for the tooth.

ADDITIONAL TREATMENT

If the initial Root Canal does not relieve the patient of pain, or if a tooth which has previously had a root canal becomes re-infected, several courses of treatment may be taken:

Antibiotic Regimen

Depending on the case, the patient may be placed on a regimen of strong antibiotics. This is an attempt to eliminate any remaining bacteria preventing the area from healing. X-rays should be taken before and after the regimen to compare the amount of infection. If the problem returns after the antibiotic is completed, the patient will need one of the additional treatments below.

Retreat Of Root Canal

A tooth which has had a primary root canal can be sent to an Endodontist (root canal specialist) for the tooth to be retreated. The specialist will remove the initial root canal material, drain the tooth of any reoccurring infection, and search for additional nerve tissue. Then the tooth will be resealed, requiring a new Core Build-Up.

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Apicoectomy

An Apicoectomy is a minor surgical procedure in which an Endodontist (root canal specialist) or an Oral Surgeon approaches the tip of the root through the gingival area above the tooth. The area is curettage of any infection and washed with an anti-microbial solution. A capping is placed onto the tip of the root, and the surgical area is sutured closed. Although successful in many cases, an apicoectomy is often thought of as the final attempt in treating a tooth.

Extraction

At any time, the patient has the right to extract the tooth over any other treatment. When the Pulp becomes infected or a root canal fails, an Extraction is always a viable option. When making this decision, however, the patient needs to understand the cost of replacing the missing tooth with a Bridge, a Removable Partial Denture, or an Implant.